II. Multidisciplinary Evaluation Procedures

Purpose of the Multidisciplinary Evaluation

Under federal and State law and regulations, children thought to be eligible (e.g., referred with a suspected or confirmed disability) for the EIP are entitled to a multidisciplinary evaluation.12 The multidisciplinary evaluation is necessary to:

  • determine whether a child is eligible for the Early Intervention Program;
  • assess the status of the child's physical, cognitive, communication, social-emotional, and adaptive development;
  • identify areas of developmental strengths and needs; and,
  • learn and understand the parent's resources, priorities, and concerns related to their child's development.

The initial multidisciplinary evaluation and assessment results are fundamental to documenting children's eligibility for services under the EIP. While the evaluation includes an assessment of the unique needs of the child in each developmental domain, including the identification of services appropriate to meet those needs, the evaluator should avoid making recommendations regarding the frequency, intensity, and duration of specific services until such time as the family's total priorities, resources, and concerns have been assessed and the total plan for services under the IFSP is under discussion.13 In addition, the evaluation or assessment must not include a reference to any specific provider of early intervention services.14 The decisions about the frequency, intensity, and duration of services to be provided to a child and family, or about the provider(s) to deliver EIP services, are not recommended as part of the evaluation. These decisions must be made during the IFSP meeting when the goals, services and strategies necessary to assist the child and family in meeting those goals are agreed upon. The results of the multidisciplinary evaluations and family assessments are an important source of information for development of IFSPs to meet children's developmental strengths and needs, and the priorities, resources, and concerns of families related to their child's development.

It is important to note that for children who are found eligible on the basis of a diagnosed condition with a high probability of resulting in developmental delay, such as Down syndrome, cerebral palsy, extreme prematurity, etc., a primary purpose of early intervention is to mitigate the impact of the condition on a child's developmental progress. These children do not have to be experiencing developmental delays to receive specific services available under the EIP. In determining outcomes to be achieved for these children and the services needed to achieve child and family outcomes, the IFSP team should consider the potential impact of the condition on child development and functioning as well as information on children's developmental status obtained through the evaluation process.

General Requirements for the Evaluation Process

EIP regulations at 10 NYCRR §69-4.8 detail the responsibilities of evaluators for conducting screenings, evaluations, and assessments to establish children's eligibility for the EIP. The multidisciplinary evaluation must be completed within sufficient time to develop an individualized family service plan (IFSP) within forty-five days of referral for those children found eligible for the EIP. If the time from the date of referral to the development of an IFSP exceeds forty-five days, municipalities must document the reason for the delay (including lack of timeliness in completion of a child's evaluation or submission of the evaluation summary and report to the EIO) in the child's record and in the Kids Integrated Data System (KIDS) (or other data system or data reporting mechanisms required by the Department). Under federal and State law and regulation, nondiscriminatory evaluation and assessment procedures must be used in all aspects of the evaluation and assessment process.15 Specifically, evaluation and assessment procedures must be responsive to the cultural and linguistic background of the family.

In addition, no single procedure or instrument may be used as the sole criterion or indicator of eligibility. In other words, when making a determination as to whether a child is eligible for the EIP, the multidisciplinary evaluation team must rely on information from a variety of appropriate sources, which should include standardized instruments and procedures, when appropriate or possible; observations of the child; parent interviews; informed clinical opinion; and, any other sources of information about the child's developmental status available to the team conducting the child's evaluation. This should not be interpreted as requiring that two or more standardized tests or instruments be used to evaluate the child, unless the child's developmental status clearly indicates the need for more than one standardized test (e.g., a hearing test to assess hearing loss and a standardized developmental test to assess the impact of the child's hearing loss on his/her development).

Federal and State regulations also require that evaluations must:

  • be conducted by personnel trained to utilize appropriate methods and procedures;
  • be based on informed clinical opinion; and,
  • include a review of pertinent records related to the child's current health status and medical history.16

State regulations further specify that multidisciplinary evaluations must be conducted in a professional, objective fashion and must:

  • consider the unique characteristics of the child;
  • use several sources and types of information about the child.17 Examples of other sources of information might include, with parent consent, the child's primary health care provider or medical specialists, relatives or family members, family day care or child care provider, etc.;
  • employ appropriate instruments and procedures. Instruments used as part of a multidisciplinary evaluation must be reliable and valid, have appropriate levels of sensitivity and specificity; and, be sensitive to the child's and parent's culture and dominant language or other mode of communication;18 and,
  • be conducted in a setting conducive to ensuring accurate results, and the parent's input regarding the preferred environment should be considered.19 Prior to the evaluation, parent input about the setting in which their child is likely to be most comfortable should be obtained. After the evaluation, the family should be asked whether they believe their child's response was optimal, and the family's response should be included in the evaluation summary and report.

The New York State Department of Health (Department) clinical practice guidelines include descriptions of comprehensive, in-depth assessments for children with or suspected of having autism/pervasive developmental disorders or communication disorders. The Department will be releasing four additional clinical practice guidelines, addressing motor disorders, hearing loss, vision impairment, and Down syndrome in the near future. The guideline recommendations for in-depth assessment procedures for each of these conditions should be used as part of the multidisciplinary evaluation procedures once each of the guidelines are published and disseminated. (The guidelines on assessment and intervention for children with autism/pervasive developmental disorders and communication disorders were published in 1999 and have been widely distributed.)

A Special Note on Standardized Evaluation and Assessment Instruments

Standardized evaluation, assessment and/or diagnostic instruments should be used, whenever such instruments are available and appropriate for the child's age, culture/language, and developmental concern, as part of a child's multidisciplinary evaluation to determine initial or ongoing eligibility for the EIP. Standardized evaluation and assessment instruments must be used by appropriately trained and qualified professionals. Some test developers require professionals to complete additional training and/or certification prior to using the instrument, and under these circumstances, only those professionals with this training are qualified to use the instrument. In addition, evaluators are responsible for ensuring that standardized tests are used and scored as specified in the test manual, in a manner that does not violate the psychometric properties of the test or the purpose for which the test was designed. Subscores returned on standardized tests must be used in a manner consistent with the test manual, and are generally not averaged unless the manual provides explicit instructions for use of subscores in this manner. Standardized instruments selected should be norm-referenced to the population to be evaluated. Tests and other materials and procedures used must be administered in the child's dominant language or other mode of communication unless it is clearly not feasible to do so. When evaluation and assessment instruments are revised or re-normed and reissued by test developers, the most recent edition of the instrument should be used as soon as practicable (that is, when the new edition is available to professionals) to assure valid results.

If a child is suspected of having a condition with a high probability of resulting in developmental delay, such as autism, standardized assessment instruments designed specifically to diagnose and assess the presence of the condition should be used. The six clinical practice guidelines developed by the Department make specific recommendations on standardized assessment instruments and clinical procedures for evaluation of children with autism/pervasive developmental disorders, communication disorders, Down syndrome, motor disorders, hearing loss, and vision impairment.

There are two types of standardized tests that are used to assess children's developmental status. The use of each of these two types of tests to determine eligibility for the EIP is briefly described below.

Norm-referenced, standardized tests yield standard scores, standard deviations, and percentile ranks that are derived in relationship to a normal distribution, and therefore have a consistent and predictable relationship to each other and provide comparable information about a child's performance relative to a normative sample. Standard deviation scores, deviation quotients, and percentile ranks are all acceptable ways of reporting test scores to document children's eligibility, when norm-referenced, standardized instruments are used.

However, some norm-referenced tests also yield a "developmental age" or "age equivalency" score. These scores represent the chronological age of the children in the sample for whom a specific raw score was the mean score (i.e., the scores represent a mathematically calculated performance rather than actual performance of children in the standardization sample [Andersson, 2004]). Assessment experts discourage the reporting of age-equivalent/developmental age scores because these scores do not provide comparative information and do not indicate the presence of a disorder or delay. These scores do not indicate what a child's performance should be, nor do they indicate qualitative differences in a child's performance. In addition, a reduction in an age equivalent score does not have the same consequence at all stages of development or across all developmental domains. Finally, these scores can be imprecise, because age-equivalent scores may not be available to match the full range of chronological ages.

Age-equivalent or developmental age scores derived from standardized tests should not be used for eligibility determinations unless the test manual explicitly indicates that the test has been designed to calculate percentage of delay and the manual provides data to support the use of these scores as valid and reliable.

Criterion-referenced tests are not designed to compare one child's performance to other children. Criterion-referenced instruments are helpful in assessing children's functionality, measuring progress, and linking assessment to intervention; however, these tests generally do not provide sufficient information to determine the extent to which a child is experiencing developmental delays. In addition, criterion-referenced tests can be helpful in evaluating children for whom norm-referenced tests are not available or appropriate due to the child's age, condition, language/culture, or other factors that influence test performance. Criterion-reference tests can be used in conjunction with other methods of gathering information about a child's development (e.g., parent report, observation, etc.) and informed clinical opinion to establish a child's eligibility based on level of developmental delay.

Norm-referenced test are known to have a higher degree of reliability and validity than criterion-referenced tests, and are specifically designed for use in comparing the performance of an individual child to the performance of a referent group (for example, children of the same age). Norm-referenced tests should be used, whenever possible and appropriate to the child's individualized needs, as part of the eligibility determination process. Norm-referenced tested can be particularly helpful when evaluating children who are referred to the EIP based only on a concern about development and when no underlying condition with a high probability of resulting in developmental delay is suspected or confirmed.

See Andersson, L. "Appropriate and Inappropriate Interpretation and Use of Test Scores in Early Intervention," Journal of Early Intervention, 2004, Vol. 27, No.1, pp 55-68 for an excellent discussion on these issues.

A Special Note on Informed Clinical Opinion

In guidance issued by the Department in 1999 (EIP Memorandum 1999-2), it was emphasized that diagnostic instruments and informed clinical opinion must be used in combination to interpret results of the comprehensive evaluation, determine the degree of developmental delay, and formulate a statement of eligibility where the evaluator has determined that a child meets State eligibility criteria. Informed clinical opinion for purposes of the EIP is defined at 10 NYCRR §69-4.1(w) as "the best use of quantitative and qualitative information by qualified personnel regarding a child, and family if applicable. Such information includes, if applicable, the child's functional status, rate of change in development, and prognosis." Informed clinical opinion is more generally used to describe professionals' use of qualitative and quantitative information to assess a child's development. The use of informed clinical opinion and diagnostic procedures is particularly important when, due to the child's age, culture, language, and/or nature of the developmental problem or concern, standardized instruments are not available or appropriate.

When using informed clinical opinion in the evaluation process, practitioners draw upon clinical training and experience; standardized instruments, as available and appropriate; recognized clinical assessment procedures (e.g., observation techniques; interviewing techniques; use of objective measurement techniques specific to the developmental problem or circumstances and concerns related to child and family, etc.); experience with children of different cultures and languages; and, their ability to gather and include family perceptions about children's development. Clinicians should also refer to recognized clinical practice guidelines and standards, including the Department's clinical practice guidelines. An article on informed clinical opinion is available through the Web site of the National Early Childhood Technical Assistance Center (NECTAC) at http://www.nectac.org/.20

A Special Note on Parent Participation in the Multidisciplinary Evaluation Process

EIP regulations require that parents have the opportunity to participate in the performance of screenings, evaluations, and assessments unless the parent's circumstances prevent the parent's presence.21 For children in the care and custody, or custody and guardianship, of the local social services commissioner, the commissioner or designee (i.e., the child's case worker or other local department of social services staff designated by the commissioner) may be present in lieu of a parent (or surrogate parent) who elects not to participate.22

The importance of parental involvement in the performance of children's multidisciplinary evaluations (which include by definition, screenings, evaluations, and assessments) cannot be overstated. Parents should always be present and participate in the child's evaluation, unless there are exceptional circumstances as to why the parent(s) cannot be present. The presence and participation of a parent (or parents) is necessary for many reasons. Parents have a responsibility to be informed about, understand, and consent to the evaluation procedures. In addition, parents can assist the multidisciplinary evaluation team with the evaluation process, can help elicit optimal responses from their children and/or can help the team understand the extent to which children's responses are typical/optimal.

The evaluation team is required to conduct a parent interview about the family's resources, priorities, and concerns about the child's development and developmental progress.23 With the parent's consent, the evaluation team may also interview other family members or individuals who have pertinent knowledge about the child's development (e.g., child care providers). Children's parents have critical information about their children to share and are integral to the evaluation process.

Parental presence and participation in their child's multidisciplinary evaluation is important to facilitating parents' understanding of evaluation results. The multidisciplinary evaluation team is responsible for fully sharing the results of child evaluations with parents following the completion of evaluations and assessments. Parents must be afforded the opportunity to discuss the evaluation results with evaluators, including any concerns they have with the evaluation process.

Intake and Screening Procedures

The evaluator is responsible for obtaining parental consent to perform the screening and/or evaluation prior to initiating evaluation procedures. The evaluator may, with parent consent, screen the child to determine what type of evaluation, if any, is necessary unless the child has a confirmed diagnosis with a high probability of resulting in developmental delay.24 When a child has a confirmed diagnosis of a condition with a high probability of resulting in developmental delay (such as Down syndrome), a full multidisciplinary evaluation must be performed for the child.25

While parents always have the option to pursue a multidisciplinary evaluation for their child upon referral to the EIP, there are some circumstances when performance of a screening is appropriate. Screening tests are generally intended to be brief, easy to administer, and lead to a yes/no decision as to whether or not a developmental problem is likely and further in-depth assessment/evaluation is needed. The evaluator is responsible for determining what type of screening should be conducted (for example, whether a screening should address one or more domains of development, or if the screening should address a specific concern, such as potential hearing loss).

Circumstances under which it may be appropriate for an evaluator to conduct a screening include when there are:

  • concerns about only one area of development (e.g., communication development, physical development, etc.), or if there is a generalized concern about the child's development, a screening may be conducted to determine whether the child is typically developing or whether there are indications of problems that require further evaluation and assessment; or,
  • very specific concerns for which procedures exist to clearly "rule out" or identify a problem (e.g., hearing loss).

Screenings may be helpful in the following ways:

  • When a screening indicates that a child's development is within normal range, and no problems or delays are identified, parental concerns can be alleviated without necessitating that the child and family undergo a full evaluation (unless the parent requests a full evaluation).
  • Screenings can assist the evaluator in deciding upon the most effective composition of the child's multidisciplinary evaluation team. For example, if a screening indicates that a child's communication development is age appropriate, but motor development is delayed, the multidisciplinary evaluation team should include a professional who can assess the child's motor functioning.

If the screening results are within normal limits, the child is not eligible for the EIP and does not require a full multidisciplinary evaluation. The evaluator must inform the parent of the results of the screening, including that the child's development is appropriate and further evaluation is not indicated at this time. The evaluator must prepare and submit a report to the Early Intervention Official, parent, and with parent consent, the child's primary health care provider. The evaluator may recommend developmental surveillance for the child, if appropriate. If the parent requests a full multidisciplinary evaluation for the child, the evaluator must provide a multidisciplinary evaluation.

If the screening indicates cause for concern, a multidisciplinary evaluation must be completed to determine whether the child is eligible for the EIP. It is important to note that the multidisciplinary evaluation must include an in-depth assessment of all five areas of development, regardless of screening results.

When a screening is completed as part of the evaluation process, the evaluator must use, whenever feasible and appropriate, standardized instruments with demonstrated reliability and validity, and appropriate sensitivity and specificity.26 In addition, parents must consent to and be present for the screening, unless the parent's circumstances prevent the parent's presence.

Evaluators who perform a screening are responsible for discussing the results of the screening with the parent, facilitating the parent's understanding of the screening results, and addressing any concerns identified by the parent.

Composition of the Evaluation Team

The composition of the multidisciplinary evaluation team is critical to ensuring accurate and comprehensive results, including a diagnosis, if appropriate. At a minimum, the team must include two differently qualified professionals.27 In addition, State EIP regulations stipulate that at least one member of the evaluation team must be a specialist in the area of the child's suspected delay or disability, if known.28 The team must be trained in appropriate methods and procedures, and across the members of the team, have sufficient expertise to fully assess all five developmental domains. At least one member of the team must also have expertise and be trained in appropriate methods and procedures to conduct the family assessment (optional to the parent[s]).

In determining the composition of the multidisciplinary evaluation team, the evaluator should consider the concerns expressed by the parent regarding the child's development, information available from the referral source (e.g., diagnostic information, medical/developmental history, etc.), and screening results if a screening was conducted. If a child is referred with a suspected diagnosed condition with a high probability of developmental delay, or a suspicion of such a condition emerges during the evaluation, it is important for the multidisciplinary evaluation team to assist the family in obtaining a diagnosis. For example, the multidisciplinary evaluation team should be comprised of, or expanded to include, professionals who are qualified to diagnose the suspected condition (e.g., autism/pervasive developmental disorders, cerebral palsy, etc.). Appendix B, which may also be found in Early Intervention Guidance Memorandum 1999-2, on reporting children's eligibility, contains a list of eligible conditions and information about which professionals are qualified to diagnose them. The multidisciplinary evaluation team may recommend that a supplemental evaluation (conducted either by a physician or other personnel qualified to make a diagnosis) be completed for this purpose.

Required Components of the Multidisciplinary Evaluation

Evaluators are responsible for ensuring that evaluations are conducted in a manner consistent with State and federal law and regulations.

Under the EIP regulations, the following components must be included in performance of multidisciplinary evaluations:

  1. A parent interview about the family's resources, priorities, and concerns related to the child's development and developmental progress. Interviews with other family members or individuals knowledgeable about the child, such as childcare providers, may be conducted with parent consent.29
  2. With parent consent, a review of pertinent records related to the child's current health status and medical history.
  3. An evaluation of the child's level of functioning in each of five developmental domains: cognitive, physical (including vision and hearing), communication, social or emotional, and adaptive development.30 The evaluation of the child's physical development must include a health assessment. The health assessment is comprised of a physical examination, routine vision and hearing screening, and where appropriate, a neurological assessment.

    If a health assessment has recently been completed in accordance with schedules recommended by the American Academy of Pediatrics (see Appendix C, or access the chart on the AAP website31), however, and there are no clinical indications that a re-examination is necessary, the evaluator shall, with parental consent, rely on a record review to meet the requirements for the health assessment.32

  4. With parent consent, findings from current examinations, evaluations or assessments, in addition to health assessments described above that have been performed for the child, may be used to augment and not replace the multidisciplinary evaluation to determine eligibility, as long as these assessments have been performed in a manner consistent with the requirements for multidisciplinary evaluations, and no clinical indicators are present to suggest the need to repeat procedures.33
  5. An assessment of the unique needs of the child in each developmental domain, including identification of services appropriate to meet those needs. It is appropriate for evaluators to identify the types of interventions and services that are indicated for the child, and family based on the results of the evaluation. However, it is important to note that PHL §2544(5) specifically prohibits an evaluation from including reference to any specific provider of early intervention services. In addition, 10 NYCRR §69-4.8(a)(4)(iv) states that the evaluator should avoid making recommendations regarding frequency and duration of specific services until such time as the family's total priorities, concerns, and resources have been identified and the IFSP is under discussion. The evaluator should also avoid making recommendations about the intensity of specific services until the IFSP is under discussion.
  6. An evaluation of the transportation needs of the child, which must include the parent's ability or inability to provide transportation; the child's special needs related to transportation; and, safety issues and parent concerns about transportation.34 It is the evaluator's responsibility in particular to discuss the child's developmental and health concerns related to transportation in the event that the child requires transportation to early intervention services included in the IFSP. PHL §2545(3) also requires that the EIO first consider whether the parent may provide transportation to the early intervention services. Other modes of transportation can be used only if the parent can demonstrate an inability to provide appropriate transportation services.

Voluntary Family Assessment

EIP regulations at 10 NYCRR §69-4.8(a)(8) require that all parents be given the opportunity to participate in a family-directed assessment to determine the resources, priorities, and concerns of the family related to enhancement of the child's development, conducted by appropriately qualified personnel on the multidisciplinary evaluation team. Family assessments are voluntary on the part of the family; however, evaluators approved under the EIP must have the personnel resources to offer a family assessment to all families and to conduct these assessments for parents who wish to participate in a family assessment.

It is important to differentiate between the parent interview that must be conducted as part of the child's multidisciplinary evaluation and the family assessment process, which is voluntary on the part of the family. The purpose of the parent interview is to obtain information from the perspective of the child's parents, and with parent consent, from other individuals familiar with the child's development regarding concerns about the child's developmental status and progress. The parent interview assists the multidisciplinary evaluation team in assessing the unique needs of the child in each developmental domain, and the family's resources, priorities, and concerns related to the child's development. The subject of the parent interview, in other words, is the child's development. The parent interview (and/or interviews with other individuals, with the parent's consent) is a required part of the child's evaluation, focused on the child's developmental status.

The purpose of the voluntary family assessment is to assist the family in determining the resources, priorities, and concerns of the family related to enhancing their child's development. The multidisciplinary evaluation team is required to offer families the opportunity to participate in a family assessment; however, participation in this assessment process is voluntary for the family. The family assessment process is defined in EIP regulations as "the process of information gathering and identification of family priorities, resources and concerns, which the family decides are relevant to their ability to enhance their child's development."35 An important part of the family assessment process is to help the family identify the formal and informal supports and services needed by the family to assist them in enhancing their child's development. These might include both those formal supports and services available through the EIP (for example, family training, family counseling, family/parent support groups, etc.) and services needed by the child and family available through other service delivery systems, such as the Office of Mental Retardation and Developmental Disabilities' Home-and Community-Based Waiver Program), and informal supports and community resources available to the family (for example, recreational programs and facilities, family and friends, neighbors, etc.) that can assist the family in enhancing their child's development. The focus of the family assessment is the family and their priorities, resources, and concerns related to their child's developmental needs.

When carried out, family assessments must:

  • be conducted by qualified personnel trained to utilize appropriate methods and procedures;
  • be based on information provided by the family through a personal interview;
  • incorporate the family's description of its resources, priorities, and concerns related to enhancing the child's development; and,
  • be completed within a sufficient time frame to enable convening of the IFSP meeting within 45 days of the date of the child's referral to the EIP.36

The family assessment is not intended to be a professional assessment of the family's functioning, as might occur in other types of service delivery settings or circumstances. Professional assessments of family functioning can be provided under the EIP if these services are included in the IFSP (for example, through social work services, family counseling, etc., related to the impact of the child's developmental problems on the parent(s)/family unit). Because the voluntary family assessment is intended to be a family-directed process to identify the family resources, priorities, and concerns related to enhancing their child's development, the family assessment may be conducted by any member (or members) of the multidisciplinary evaluation team who is trained in methods and procedures to conduct the family assessment. As part of the family assessment process, the evaluator should discuss with the parent how the results of the family assessment should be documented, including what information should be included in the evaluation report.

Use of Findings From Other Examinations

Evaluators may use findings from other current examinations, evaluations, assessments, or health assessments performed for the child, with parental consent, including those conducted prior to the initiation of the multidisciplinary evaluation. This can facilitate the timeliness of the evaluation process by reducing the amount of time needed to complete the evaluation, and by reducing the number of professionals involved and/or evaluations that must be completed. Use of such findings will also ensure that children do not have to undergo duplicative or unnecessary evaluation procedures. Under these circumstances, the evaluator must ensure that:

  • the procedures were performed in a manner consistent with EIP requirements;
  • the findings are used to augment and not replace the multidisciplinary evaluation to determine eligibility; and,
  • there are no indications present which suggest the need to repeat such procedures (e.g., the strengths/needs of the child have changed sufficiently to warrant re-examination).

In addition, where feasible the evaluation team should consult with the professional(s) who performed the procedures being reviewed as part of the child's multidisciplinary evaluation for the EIP.37

If a child has been evaluated using a specific standardized instrument/test/procedure prior to his/her referral to the EIP, the EIP multidisciplinary evaluation team is responsible for determining whether it is necessary and appropriate (i.e., will not impact the validity/reliability of test scores) to repeat the instrument/test/procedure. The multidisciplinary evaluation team is responsible for ensuring that all required components of the evaluation are completed, and may rely on existing records for components of the evaluation to the extent these records are current and appropriate.

Finally, if a child is referred to the EIO as having a diagnosed physical or mental condition with a high probability of resulting in developmental delay, which has also been identified on the Department's list of conditions that establish a child's eligibility for the EIP, the evaluator is responsible for confirming that the child has the condition and is eligible for the EIP based on the presence of the condition. The evaluator will frequently be able to confirm the presence of the child's condition by requesting and receiving, with parental consent, the records of other current examinations, evaluations, assessments, or health assessments performed for the child. In particular, genetic and/or medical conditions included on the Department's list of conditions that establish eligibility for the EIP (such as Down syndrome, Fragile X syndrome, extreme prematurity in infants, etc.) will usually be able to be confirmed through a review, with parent consent, of a child's medical records. Under these circumstances, it is unnecessary for the multidisciplinary team to perform or request that any additional tests or assessments be performed to confirm the presence of the condition.

However, there may be circumstances under which the evaluator has insufficient information to confirm the presence of a diagnosed condition with a high probability of resulting in developmental delay. This could be a result of lack of parental consent to access necessary records, or insufficient information or findings from the results of other examinations, assessments, or health assessments in records that have been provided to the evaluator. These circumstances are more likely to occur when children are referred with conditions that are identified on the basis of behavioral and developmental assessments (such as autism/pervasive developmental disorders) or when children are referred on the basis of a screening that requires follow-up (for example, infants referred through universal newborn hearing screening with suspected hearing loss). Under these circumstances, it is within the purview of, and the responsibility of, the evaluator, to complete whatever appropriate tests and procedures are necessary to establish the child's eligibility for the EIP (whether on the basis of a diagnosed physical or mental condition with a high probability of resulting in developmental delay, or the presence of a developmental delay).

12 34 CFR §303.322; PHL §2544 (1)
13 10 NYCRR §69-4.8(4)(iv)
14 10 NYCRR §69-4.8(15)
15 34 CFR §303.323; 10 NYCRR §69-4.8(14)
16 34 CFR §303.323; 10 NYCRR §69-4.8
17 10 NYCRR §69-4.8(6)
18 10 NYCRR §69-4.8(6)(i)
19 10 NYCRR §69-4.8(6)(ii)
20 Shackelford, J. (2002). Informed clinical opinion (NECTAC Notes No. 10). Chapel Hill: The University of North Carolina FPG Child Development Institute, National Early Childhood Technical Assistance Center
21 10 NYCRR §69-4.8(a)(2)(iii) and (7)
22 10 NYCRR §69-4.8(a)(2)(iii)
23 10 NYCRR §69-4.8(a)(4)(iii)
24 10 NYCRR §69-4.8(a)(2)(i)
25 10 NYCRR §69-4.8(a)(2)(i)(a)
26 10 NYCRR §69-4.8(a)(2)(ii)
27 10 NYCRR §69-4.8 (a)(3)
28 10 NYCRR §69-4.8(a)(3)
29 10 NYCRR §69-4.8 (a)(4)(iii)
30 10 NYCRR §69-4.8(a)(4)(i)
31 http://aappolicy.aappublications.org/cgi/reprint/pediatrics;105/3/645.pdf
32 10 NYCRR §69-4.8(a)(4)(a)(1)
33 10 NYCRR §69-4.8 (a)(5)
34 10 NYCRR §69-4.8(a)(4)(v)
35 10 NYCRR §69-4.1(o)
36 10 NYCRR §69-4.8(8)(a)(1)
37 10 NYCRR §69-4.8(a)(5)(iv)

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